An investigation of scale effects in family substance abuse treatment programs.

Lee AJ - Subst Abuse Treat Prev Policy (2010)

Bottom Line:
State officials were concerned that the "scale" or size of these programs (averaging just eight families) was too small to be economical.This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point.In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model.

Affiliation: Department of Community Health and Sustainability, School of Health and Environment, University of Massachusetts Lowell, 300 Weed Hall, 3 Solomont Way Lowell, MA 01854, USA. AJames_Lee@uml.edu

ABSTRACTThis short report investigates scale effects in family substance abuse treatment programs. In Massachusetts, the family substance abuse treatment programs were much more costly than other adult residential treatment models. State officials were concerned that the "scale" or size of these programs (averaging just eight families) was too small to be economical. Although the sample size (just nine programs) was too small to permit reliable inference, the data clearly signalled the importance of "scale effects" in these family substance abuse treatment programs. To further investigate scale effects in family substance abuse treatment programs, data from the Center for Substance Abuse Treatment's (CSAT's) Residential Women and Children and Pregnant and Postpartum Women (RWC-PPW) Demonstration were re-analyzed, focusing on the relationship between cost per family-day and the estimated average family census. This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point. In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model. The new programs are larger than the former family treatment programs, with each new program having capacity to treat 11 to 15 families depending on family makeup.

Mentions:
Now what accounts for these cost differences across programs? Could it be the scale differences in these comparatively small programs? In Figure 1, the direct care cost per family-day is plotted against the number of family-days. The downward sloping line represents the best bivariate linear fit to the data. As we see, a simple linear regression model suggests that the direct care costs fall pretty sharply as client volume increases. In Figure 2, the direct care cost per person-day is similarly plotted against the number of person-days, and the result is much the same. The bivariate regression line likewise suggests that the direct care costs decline quickly as client volume increases. In both cases, the right-hand-side scale variables are significant at the 0.05 level or better.

Mentions:
Now what accounts for these cost differences across programs? Could it be the scale differences in these comparatively small programs? In Figure 1, the direct care cost per family-day is plotted against the number of family-days. The downward sloping line represents the best bivariate linear fit to the data. As we see, a simple linear regression model suggests that the direct care costs fall pretty sharply as client volume increases. In Figure 2, the direct care cost per person-day is similarly plotted against the number of person-days, and the result is much the same. The bivariate regression line likewise suggests that the direct care costs decline quickly as client volume increases. In both cases, the right-hand-side scale variables are significant at the 0.05 level or better.

Bottom Line:
State officials were concerned that the "scale" or size of these programs (averaging just eight families) was too small to be economical.This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point.In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model.

Affiliation:
Department of Community Health and Sustainability, School of Health and Environment, University of Massachusetts Lowell, 300 Weed Hall, 3 Solomont Way Lowell, MA 01854, USA. AJames_Lee@uml.edu

ABSTRACTThis short report investigates scale effects in family substance abuse treatment programs. In Massachusetts, the family substance abuse treatment programs were much more costly than other adult residential treatment models. State officials were concerned that the "scale" or size of these programs (averaging just eight families) was too small to be economical. Although the sample size (just nine programs) was too small to permit reliable inference, the data clearly signalled the importance of "scale effects" in these family substance abuse treatment programs. To further investigate scale effects in family substance abuse treatment programs, data from the Center for Substance Abuse Treatment's (CSAT's) Residential Women and Children and Pregnant and Postpartum Women (RWC-PPW) Demonstration were re-analyzed, focusing on the relationship between cost per family-day and the estimated average family census. This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point. In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model. The new programs are larger than the former family treatment programs, with each new program having capacity to treat 11 to 15 families depending on family makeup.